Continuation of the NuMoM2b Heart Health Study

项目摘要/摘要 心血管疾病是美国所有年龄段女性死亡和发病的主要原因， 在针对妇女的心血管疾病预测和预防战略方面存在很大的知识差距。NuMoM2B心 健康研究(nuMoM2B-HHS)跟踪了4475名登记和 在他们的第一次怀孕期间有丰富的表型，预期收集的数据和生物谱长达7 之后的几年里。NuMoM2B-HHS的总体科学目标是定义 不良妊娠结局(APO)和心血管疾病以优化心血管疾病的预测、预防和治疗 针对女性的战略。继续跟踪这一群体，在现有高质量基础上再接再厉 数据、生物标本和行政结构，以及用于辅助研究发展的强有力的框架 和实施，提供了一个独特的机会来解决关于早期的知识差距 女性脑血管病的发病机制和发展轨迹。我们建议通过以下途径继续开展nuMoM2B-HHS后续行动 每半年接触一次，并在赠款3-5年期间亲自访问以评估心血管疾病风险因素(目标1)。 积累的纵向数据和生物谱将作为一个可广泛访问的平台，用于辅助 研究以确定心血管疾病的早期机制，并解决其他NIH优先领域，包括早期 育龄妇女脑血管和肾脏疾病的临床表现。辅助研究(目标2) 将在后续联系人和面对面访问期间扩大数据收集，并添加到计划的联系人中 时间表，以便能够有效地瞄准优化预测性和预防性所需的知识差距 战略。具体目标反映了对发病率和发病机制研究的多方面方法。 关于育龄妇女心血管疾病发展的研究，重点是妇女心血管疾病危险因素的发生率 伴和不伴APOS(目标3)；致动脉粥样硬化表型与睡眠障碍的关系 怀孕期间和怀孕后的呼吸和6-15年后估计的心血管疾病风险(目标分别为4和5)； 以及确定影响或调节这些联系的可修改因素(目标6)。 这一应用程序具有几个反映队列长期成功潜力的优势：(1) NuMoM2B-HHS将由三名经验丰富的专业人员领导，他们在以下领域具有互补的专业知识 心脏病学、母胎医学和生物统计学。(2)网络拥有强大的基础设施，可 保持长期的参与者参与度，并支持严格的数据收集。(3)队列的高质量 在支持资源共享的监管框架下收集了数据和生物武器 在未来的研究中使用。(4)网络建立了成功提出、审查和 实施辅助研究。这种强大的领导力、强大的管理和运营基础 基础设施和实现的长期愿景将为nuMoM2B-HHS提供理想的环境 继续解决有关育龄妇女心血管疾病发展的严重知识空白问题。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in U.S. women at all ages, and large knowledge gaps exist in CVD predictive and preventive strategies for women. The nuMoM2b Heart Health Study (nuMoM2b-HHS) has followed a demographically diverse cohort of 4,475 women enrolled and richly phenotyped during their first pregnancy, with data and biospecimens prospectively collected for up to 7 years thereafter. The overarching scientific goal of the nuMoM2b-HHS is to define the relationship between adverse pregnancy outcomes (APOs) and CVD to optimize CVD prediction, prevention, and treatment strategies for women. Continued follow-up of this cohort, building on a foundation of existing high-quality data, biospecimens, and administrative structures with a robust framework for ancillary study development and implementation, provides a unique opportunity to address knowledge gaps regarding the early mechanisms and trajectory of CVD in women. We propose to continue nuMoM2b-HHS follow-up through semiannual contacts and an in-person visit to assess CVD risk factors during grant years 3-5 (Aim 1). Accumulated longitudinal data and biospecimens will serve as a broadly accessible platform for ancillary studies to identify early mechanisms of CVD and to address additional NIH priority domains including early manifestations of cerebrovascular and renal disease in reproductive-age women. Ancillary studies (Aim 2) will expand data collection during the follow-up contacts and in-person visit, and add to the planned contact schedule, to permit the effective targeting of knowledge gaps required to optimize predictive and preventive strategies. The Specific Aims reflect a multifaceted approach to the study of the incidence and mechanisms of CVD development in women of reproductive age, focusing on the incidence of CVD risk factors in women with and without APOs (Aim 3); the associations between atherogenic phenotypes and sleep-disordered breathing during and after pregnancy and estimated CVD risk 6-15 years later (Aims 4 and 5, respectively); and identification of modifiable factors that influence or moderate these associations (Aim 6). This application has several strengths that reflect the potential for long-term success of the cohort: (1) The nuMoM2b-HHS will be led by three deeply experienced PIs with complementary domains of expertise in cardiology, maternal-fetal medicine, and biostatistics. (2) The network has robust infrastructure in place to maintain long-term participant engagement and support rigorous data collection. (3) The cohort's high-quality data and biospecimens have been collected under regulatory frameworks that support resource sharing and use in future research. (4) The network has established processes for successfully proposing, reviewing, and implementing ancillary studies. This foundation of strong leadership, robust administrative and operational infrastructure, and actualized long-term vision will provide an ideal environment for the nuMoM2b-HHS to continue to address critical knowledge gaps concerning CVD development in women of reproductive age.